It can feel to other people that these things are
done calmly and deliberately  almost cynically.
But we know that someone who self-harms is usually
in a state of high emotion, distress and unbearable
inner turmoil. Some people plan it in advance, for
others, it happens on the spur of the moment. Some
people self-harm only once or twice, but others do
it regularly - it can be hard to stop.

Some of us harm ourselves in less obvious, but still
serious, ways. We may behave in ways that suggest we
don't care whether we live or die  we may take
drugs recklessly, have unsafe sex, or binge drink.
Some people simply starve themselves.

Otherwordsthatareusedtodescribeself-harm

These terms were previously used to describe
self-harm, but are now going out of use:

Deliberateself-harm(DSH):
the word 'deliberate' tended to blame people for
their self-harm.

Suicide/Parasuicide: these
suggested that harming yourself is the same as
wanting to kill yourself - which is often not
the case.

Howcommonisself-harm?

About 1 in 10 young people
will self-harm at some point, but it can happen
at any age.

The research probably
under-estimates how common self-harm is. It is
usually based on surveys of people who go to
hospital or their GP after harming themselves.
However, we know that a lot of people do not
seek help after self-harm. Some types of
self-harm, like cutting, may be more secret and
so less likely to be noticed.

In a recent study of over
4000 self-harming adults in hospital, 80% had
overdosed and around 15% had cut themselves. In
the community, it is likely that cutting is a
more common way of self-harming than taking an
overdose.

Who self-harms?

It happens more often in

young women.

prisoners, asylum seekers,
and veterans of the armed forces

gay, lesbian and bisexual
people: this seems, at least in part, due to the
stress of prejudice and discrimination

a group of young people who
self-harm together: having a friend who
self-harms may increase your chances of doing it
as well

people who have experienced
physical, emotional or sexual abuse during
childhood.

What makes people self-harm?

Research has shown that many people who harm
themselves are struggling with intolerable distress
or unbearable situations. A person will often
struggle with difficulties for some time before they
self-harm.

Common problems include:

physical or sexual abuse

feeling depressed

feeling bad about yourself

relationship problems with
partners, friends, and family

being unemployed, or having
difficulties at work

You may be more likely to harm yourself if you feel:

that people dont listen to
you

hopeless

isolated, alone

out of control

powerless  it feels as
though there's nothing you can do to change
anything.

It's more likely to happen if you are using alcohol
or drugs  it may feel that these are as out of
control as the rest of your life.

You may feel like harming yourself if you want to
show someone else how distressed you are or to get
back at them or to punish them. This is not common 
most people suffer in silence and self-harm in
private.

How does it make you feel?

Self-harm can help you to feel in control, and
reduce uncomfortable feelings of tension and
distress. If you feel guilty, it can be a way of
punishing yourself and relieving your guilt. Either
way, it can become a 'quick fix' for feeling bad.

Does this mean I'm mentally ill?

Probably not. However, you may be depressed, have
personality difficulties, find it difficult to get
on with other people or have problems with alcohol
and/or drugs. You could still do with some help.

Is self-harm the same as attempted suicide

Usually not. But if you start to harm yourself, the
risk of killing yourself is greater than for people
who don't self-harm. So anyone who self-harms should
be taken seriously and offered help.

Getting help

A lot of people who self-harm don't ask for help.
Why not? You might be aware that you have some
serious problems, but don't feel that you can tell
anyone  so you dont talk about it. You may not
feel that you do have a serious problem, but see
self-harm as a way to cope with life. Unfortunately,
at the moment, if you do go to hospital after
self-harming, you've only got a 50:50 chance of
being seen by a specialist in this area.

Dangersigns

You are most likely to harm yourself badly if you:

use a dangerous or violent
method

self-harm regularly

don't see many people

have a mental illness.

You should really see someone who has a lot of
experience of helping people who self-harm, and who
knows about mental health problems.

What help is there?

Talkingwithanon-professional

You may find it helpful just to talk anonymously to
someone else about what is happening to you. Knowing
that someone else knows what you are going through
can help you to feel less alone with your problems.
It can also help you to think about your
difficulties more clearly  maybe even see ways of
solving them that you wouldn't think of on your own.
You can do this on the internet or by telephone.
Telephone helplines are listed at the end of this
leaflet.

Self-helpgroups

A group of people, who all self-harm, meet regularly
to give each other emotional support and practical
advice. Just sharing your problems in a group can
help you to feel less alone - others in the group
will almost certainly have had similar experiences.

Helpwithrelationships

Self-harm is often the result of a crisis in a close
relationship. If this is the case, get some help
with sorting out the relationship - it may be more
difficult in the short-term, but it will be better
for you (certainly less dangerous) in the
long-term.

Talkingwithaprofessional

One-to-one talking treatments can help, such as:

Problem solving therapy

Cognitive behavioural therapy

Psychodynamic psychotherapy.

Familymeetings

If you are still living with your family, it may
help to have a family meeting with a therapist. This
can help to relieve the tiring, daily stress for
everyone in the family. It is not always
appropriate, for instance, if you are the victim of
physical or sexual abuse within your family.

Grouptherapy

This is different from a self-help group. A
professional will lead (or facilitate) the group to
help the members to deal with problems they share,
for example, in getting on with other people.

Whatworksbest?

There isn't much good evidence yet of which
therapies work well for people who have harmed
themselves. However, what evidence there is,
suggests that problem-solving therapy and cognitive-behavioural
therapy are useful. A health professional will make
suggestions based on your individual problems and on
what is available locally.

What if I don't get help?

About 1 in 3 people who self-harm for the first time
will do it again during the following year.

About 3 in 100 people who
self-harm over 15 years will actually kill
themselves. This is more than 50 times the rate
for people who don't self-harm. The risk
increases with age and is much greater for men.

Cutting can give you
permanent scarring. If nerves or tendons are
damaged by cutting, this can lead to numbness or
weakness.

How can I help myself?

The feelings of self-harm will go away after a
while. If you can cope with your distress without
self-harming for a time, it will get easier over the
next few hours. You can:

Talk to someone  if you are
on your own perhaps you could phone a friend.
Telephone helplines are listed at the end of
this leaflet.

If the person you are with is
making you feel worse, go out.

Distract yourself by going
out, listening to music, or by doing something
harmless that interests you.

Find another way to express
your feelings such as squeezing ice cubes (which
you can make with red juice to mimic blood if
the sight of blood is important), or just
drawing red lines on your skin.

Give yourself some 'harmless
pain' - eat a hot chilli, or have a cold shower.

Focus your mind on positive
things.

Be kind to yourself  allow
yourself to do something harmless that you
enjoy.

Write a diary or a letter, to
explain what is happening to you  no one else
needs to see it.

When you don't feel like harming yourself

When the urge has gone, and you feel safe, think
about the times that you have self-harmed and what
(if anything) has been helpful.

Go back in your mind to the
last time when you did not want to self-harm,
and move forward in your memory from there.

Think about where you were,
who you were with, and what you were feeling?

Try to work out why you began
feeling like you did.

Did your self-harm give you a
sense of escape, or relief, or control? Try to
work out something to do that might give you the
same result, but that doesn't damage you.

How did other people react?

Could you have done anything
else?

Make an audio recording. Talk
about your good points and why you don't want to
self-harm. Or, ask someone you trust to do this.
When you start to feel bad, you can play this
back to remind yourself of the parts of you that
are good and worthwhile.

Make a 'crisis plan' so you
can talk to someone instead of self-harming.
Being able to get in touch with someone quickly
can help you control your urge to self-harm.
While you are talking, your wish to harm
yourself may start to go away.

What if you don't want to stop self-harming?

If you decide that you don't want to stop
self-harming, you can still:

reduce the damage to your
body (for example, by using clean blades if you
cut yourself)

keep thinking about possible
answers to the things that make you harm
yourself

There are a number of questions to ask yourself to
see if you are ready to stop. If you can honestly
say YES to half of the questions below, or more,
then why not try stopping?

Are there at least two people
who are willing to help me stop?

Do I have friends that know
about my self-harming who I can go to if I get
desperate?

Have I found at least two
alternative safe ways that reduce the feelings
that lead me to self-harm?

Am I able to tell myself, and
to believe, that I want to stop hurting myself?

Can I tell myself that I WILL
tolerate feelings of frustration, desperation,
and fear?

If necessary, is there a
professional who will also give me support and
help in a crisis?

If I harm myself and need treatment?

You have the right to be treated with courtesy and
respect by the doctors and nurses in the Emergency
Department. Many Emergency Departments now have easy
access to a health professional who knows about
self-harm, such as a psychiatric nurse or doctor, or
a social worker. They will be able to talk with you
about how you are feeling, and to see if there are
any ways of helping you. They should be able to
properly assess all your needs, whatever they may
be. You should be able to go through your assessment
with them. Staff may want to go through a
questionnaire with you, to try to judge how at risk
you are.

What can I do if I know someone who self-harms?

It can be very upsetting to be close to someone who
self-harms - but there are things you can do. The
most important is to listen to them without judging
them or being critical. This can be very hard if you
are upset yourself- and perhaps angry - about what
they are doing. Try to concentrate on them rather
than your own feelings  although this can be hard.

Do

Talk to them when they feel
like self-harming. Try to understand their
feelings, and then move the conversation onto
other things.

Take some of the mystery out
of self-harm by helping them find out about
self-harm perhaps by showing them this leaflet,
or by using the internet or the local library.

Find out about getting help -
maybe go with them to see someone, such as their
GP.

Help them to think about
their self-harm not as a shameful secret, but as
a problem to be sorted out.

Don't

Try to be their therapist 
therapy is complicated and you have enough to
deal with as their friend, partner or relative.

Expect them to stop overnight
 it's difficult and takes time and effort.

React strongly, with anger,
hurt, or upset - this is likely to make them
feel worse. Talk honestly about the effect it
has on you, but do this calmly and in a way that
shows how much you care for them.

Struggle with them when they
are about to self-harm  it's better to walk
away and to suggest they come and talk about it
rather than do it.

Make them promise not to do
it again.

Say that you won't see them
unless they stop self-harming.

Feel responsible for their
self-harm or become the person who is supposed
to stop them. You must get on with your own
life as well. Make sure you talk to someone
close to you, so you get some support.